Saturday, November 29, 2014

Week 2: Near proposals and mini break downs

Week two: check mark!

Week 2

It's almost frightening how quickly this getting up and spending all day in the hospital has become routine. It's at the point again that I don't even look at my watch unless I have to document a time or my stomach is growling so loudly that it might be time for lunch. I honestly enjoy being around my colleagues and it beats sitting at home and studying (almost exclusively what I do when I'm not in the hospital).

People often ask why I, as a woman, would want to work in urology. Most men say that they'd prefer a male urologist (which is totally legit because I also go to a female gynecologist). None the less, I think patients in the hospital care less and probably care more when selecting a urology practice to visit. The men I talk to usually say they would feel uncomfortable having a good looking female urologist treating them (that wasn't me complimenting myself, I'm just saying what they tell me).

Well let me tell you, being a woman in urology definitely provides situations my male colleagues probably don't experience with the same frequency. I had a patient this past week who seemed to be quite fond of me. He even said that if he was still my age and not married that he'd take me on a date that night......(what does one say to that when in the position of the doctor?).  He also was always happy to have me do kidney ultrasounds on him......"See Ms. Hasselhof, we are already getting to know each other a little bit better." My colleagues even offered to do the exams on him for me....but I'm a big girl and might as well navigate my way through these kinds of situations while I'm still only the little intern.

Another patient and his family were so lovely that I took care of most of the communication with them and ended up exchanging information which might be useful in the future for travel.

The residents and interns go out for a drink almost every week. For some reason it didn't happen last week but this week it did. The Christmas market opened up in town on Wednesday and we hit it up after work. Since the only female resident was on call, it was me and the boys. Accordingly, I kept up with them in regards to hot spiced wine on the market and beers at the Irish pub (nothing a liter of water before bed can't handle). They all didn't consume as much as I imagine they would've if they didn't have to work the next morning. I respect their sense of responsibility. (Besides, we were all getting up at 6 a.m. or earlier the next morning and we were all home by 11 p.m.)

View from above: Part of the Christmas Market

Time for best and worst!

Best Moment: A few things here and there. I successfully placed 3 of 4 peripheral lines on first try this week! I did an ultrasound on a duplex kidney (two kidneys on one side). I lead an admissions conversation and examination. I was promoted to ward doctor for Thursday afternoon since the resident who was ward doctor for the week had to leave for a training program (he had finished everything that needed to be done before he left and the patients were all taken care of so really, I didn't have to do anything.....but something could've happened).

Worst Moment: That was today and I'm not even in the hospital! I've been fairly stressed lately (what else is new). With work all day and studying all night and that being a repetitive cycle, I was getting absolutely nothing else done. My scores on answering questions for the USMLE were far from satisfactory.
The way the USMLE is set up is so different from the German Medical exam. In theory, they should be asking the same information but the format of the American one is way more complex, or at least its seems so because I'm not used to it yet. I wanted to schedule my appointment for the exam in 3 weeks on the 21st of Decemeber. To my shock, neither Berlin, Frankfurt nor Munich had any available appointments within my eligibility period (ending Dec. 31st). Amsterdam had two next week, Paris a week after that and London had one of the 24th and 31st of December. Great.
Traveling would be expensive, stressful and inconvenient. I also don't feel prepared what so ever after these last few days of working through questions. I technically thought I still had 3 weeks and with a lot of blood, sweat and tears I may have made it work a bit better. This test score is just so immensely important that I felt the pressure crushing down on me again. And I wasn't even able to make an appointment.
Long story short, I extended my eligibility period for another 3 months.
Although I was looking forward to this exam studying being done by Christmas, I don't feel confident enough (and its just not possible) taking the exam at the end of December.
After paying the changing fee I called my parents and had a mini break down over FaceTime. I'd be lying if I told you this was the first one of these sorts over the past years and I wouldn't be shocked if a few more med students out there have been through the same.
I know a lot of other people are under a lot of pressure in life too but I can only speak for myself and my situation. And I tell you that going into medicine puts a LOT of pressure on you to be good, know so much, study into the wee hours, lack sleep, deal with the immense responsibility, work, work, work....It's valid to ask why anyone would voluntarily take all the pressure upon themselves. In my case its passion. Everyone has their own motivation. But it can be really, really tough sometimes. After the conversation with my parents I was feeling better and am newly motivated to get this exam done right.

It was this foggy all day long O_O

This upcoming week, I plan to have my own patient from admission to discharge. I'll suggest treatment options and procedures and see just how right my thoughts are. I think this will be a very good learning experience because up until now, everyone else was calling the shots and I just stood by and observed.

Stay tuned next week to see just how successful I was.

Sunday, November 23, 2014

Week 1

Week one: completed! (below in a pic-a-day)

It was a good week.

Getting up at 6 a.m. isn't terrible if I go to bed at 10 p.m. I'm sure I will become more lenient with the time once this life style becomes routine.

Having worked in the urology department for a month about 1 year ago, I knew most of the colleagues sitting at the morning meeting. Those that I knew still knew me.

As I said before, our main job is to work on the ward and be involved in the daily work there. And so it was that I spent the whole week on the penthouse ward (we're all the way on the top....which can get fairly annoying with the elevators) except Friday, but I'll get to that.

On the first day, the intern that has been there for the past two months gave the other new intern and I a little tour of the place and told us what our tasks would be. At first, it sounded a lot like the tasks I had two years ago and was afraid I'd sit around with nothing to do during the day and wouldn't learn anything new. (I was almost constantly busy throughout the week. Certainly also due to the fact that I don't like sitting around and will help wherever I can).

Main daily tasks:
-take notes on rounds and keep track of available beds
-draw blood
-do the kidney and bladder ultrasounds
-place peripheral venous catheters
-help compose medical reports
-order labs/imaging/consultations
-writing up prescriptions

Besides those tasks, I help where I can, make sure the doctors are happy and have chocolate on hand for sugar lows.

Being a native English speaker has also come in handy this past week. We had two patients that didn't speak German, which led to me having most of the conversations with them.

I've decided to share my best as well as my worst moment of every week. Everything in between is more or less normal hospital activities and not really worth reporting on.

Best Moment: Friday I was called down to the OR to help in an operation. I worked with two of the attendings. The operation was a kidney removal. The interesting part was that it wasn't a normal kidney. It was a horse shoe kidney. Only about 1 in 500 people have it. Instead of two kidneys, they have a fused "U" shaped kidney. So being able to operate on that isn't common and even less common is removing a tumor from it. I held hooks for most of the time but the cool moment (and the moment the attendings said I would still tell my grandchildren about) was putting my finger between the aorta and the isthmus (connecting part of the two sides)! I don't know if they were being serious that I might never have that opportunity again but hey, I'll take it. I even was allowed to sew together the skin at the end! (a good reward for back breaking hook holding hours on end)

Worst Moment: Whenever I've been out of the hospital setting for a while, I always have to get used to drawing blood and placing lines again. I used to be really good at drawing blood, even on patients that seemed tricky. Placing lines even went smoothly at some point. Practice makes (nearly) perfect. Not having drawn blood or placed lines in a long while, I new I'd have to overcome the feeling of avoiding it. I didn't have a single line to place this week so I know that is still a task I have to overcome and start again most likely this coming week. The blood draws were going really well until Thursday. From the stature of the man, you'd think it wouldn't be a problem. I tried on the left side. No luck. I tried drawing blood from the line already placed on the left side. No luck. I tried drawing blood from the right arm line. No luck. I tried drawing blood from the right arm. No luck. I would've tried until I was successful but I take the patients feelings into consideration and usually get someone ranked higher than me to try the third time. I wanted to ask the doctor I was working with that week but the attending overheard our conversation and said he'd do it. I was already embarrassed to ask my doctor because drawing blood shouldn't be that difficult and it is our task to complete (but again, I put my pride aside in favor for the patient). I was even more embarrassed that the attending now planned on drawing the blood for me. He ended up trying around 7 times and through the lines before he finally got just enough blood from his last try to fill 2 of the 3 tubes we wanted. As sucky as the situation was for the patient (who put on a strong face throughout), I was glad that it wasn't that my blood drawing skills had gone away but rather the patient was just a really hard case.

My worst moment also nicely displays my next point, this department is a great place to work. I have been in other departments were I would not have felt as safe asking for help without getting a bitter response. Everyone, from the doctors (regardless of rank) to the nurses and the OR team, everyone is nice, willing to help and doesn't look down on you but rather approaches you on eye level. I wish all my future departments to be like this. Even if someone has a grumpy moment, it quickly passes and work goes on.

I'm excited to see what this next week brings. I'm setting a little goal for myself to try something new every week if the opportunity presents itself.

Have a great rest of your Sunday and stay healthy!


Monday, November 10, 2014

German Exam: check, Vacation: check (sad face here), Research: on it, Play doctor: starting next week!

Greetings everyone!

Let me get you up to speed.

I passed my German medical board exams! The rest of the course started becoming really tedious and I was glad when it was over. The three day written exam was a roller coaster of emotions. I don't get afraid before exams, I usually stroll quite casually into a written exam. My mentality, "Either I know it or I don't." Its not like the paper can bite me and I've put in the work studying. (I do get more nervous before oral exams. Its more anticipation than fear though.)

The first day went really well and I thought that if it continued like that (which I knew it wouldn't), my dream score would totally be achievable!

The second day was a big slap in the face! They picked the most exotic cases! I don't think we've ever discussed parotid gland cancer and I get asked 15 questions about it! Or sure, go ahead and take the most absurd and not common heart malformation a newborn can have and ask me 15 questions about that. Thanks IMPP, thanks. (IMPP is the institution that creates the exams)

The third day was better than the second but not as good as the first by far. There was a site online where after each day we could enter our results (we were allowed to take the question pamphlets with us) and by the end of the day, a panel of professors had answered the questions with a near percent percentage of being correct. After Day 1 and Day 2, I was directly on the boarder between the score I thought was likely and my dream score. This put me in the position of having to get into the range of my dream score on Day 3 for it all to work out.

I missed my dream score by 5 out of 320 points.....this isn't the official score and some questions still might be removed but I doubt enough to get me in that dream score category. In the end, I can live with the score I got and no one will ever really be interested in that score anyways considering my plans to go to America.

A few days after that exam, I flew to the States for my 3 week vacation. It was fantastic. I had so much fun and met so many wonderful people! I'm still trying to recover from my high of happiness and relaxedness (by recover I mean being content with how my life is again now).

I have mixed feelings about the time coming up. Deep down I know this is exactly what I want to do and I will enjoy the ride. On the other hand, all my friends that have kept me company in G-Town have either moved away or are in the process of finding a job elsewhere (for that person in particular I hope she finds a really awesome job that she loves, but I don't want her leaving me either). I have to return to a scheduled life. This of course is all a matter of getting used to again and within 2 weeks or so it'll be completely normal. I'm taking the American board exam in December, a few days before Christmas. Studying for that will occupy my nights after work and my weekends up until then. There is some real heavy pressure on me for this one. I just want to do so incredibly well but its sometimes hard to find the energy after having gone through all the stress with the German one. But I am determined and will make it happen. This week I am in the lab working on research for my doctor thesis. In a few weeks I will probably post about how much I love being an intern and these feelings right now will be irrelevant.

I plan on keeping up on this blog on a weekly basis. Most likely, I will try to write a post every Saturday. It'll recap my week at work, what I've learned, how things went but also include some life style things (what interns wear, neat gadgets for interns, what music keeps me going, new recipes and such, whatever is happening at the time I guess.)

I hope you guys enjoy, look out for updates and go ahead and send me any questions or comments you may have. I'd love to have you all join me on this trip through my internship year!

Internship year starts November 17th! One week until I get to play doctor!

Big hug! Stay healthy!